Trans Radial Cath at NWGH Peshawar

8/4/2019 Trans Radial Cath at NWGH Peshawar

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Radial cardiac catheterization

Peripheral arterial embolization ( AVP4)

Carotid interventions


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History Procedure Advantages over femoral route Situation at NWGH Future vision

Radial Procedure


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1989 Campeau et al 1993 first PCI in Amsterdam 2005 onwards momentum started European Vs American trend

History


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Click to edit Master text stylesSecond level

Third level Fourth level

Fifth level


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Click to edit Master text stylesSecond level

Third level Fourth level

Fifth level


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AFIC ++ PIC + Tabba + NICVD + LRH + RMI - NWGH ++

Radial Catheterization .Status In Pakistan


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Long history of use

Technically easy Facilitates the use of larger

catheters/equipment

Femoral Approach


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Prolonged bed rest required Use of a closure device (which increases cost) Back pain Urinary retention Neuropathy 0.5-4.0% incidence of vascular complications

including pseudoaneurysm, a-v fistula, transfusionsand/or embolectomy

Bleeding can be significant (before it is detectedclinically)

Disadvantages


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Acceptable for female gender

Earlier patient ambulation

Advantageous for patients with difficultylaying/lot (back pain, obesity, CHF)

The vessel is easily compressible

Less chance for local nerve injury

Radial Approach


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Vascular complications are less frequent

Randomized trials to date suggestpatients prefer the radial approach


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The radial artery is smaller than thefemoral (approximately 2-2.3mm)

Obtaining radial access involves alearning curve

Smaller sheaths are required (4-8F)

Potential Disadvantages


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Vessel spasm is more common

Guide placement is more challenging and

requires learning a different technique

Many physicians are not familiar with the

equipment and anatomy, and thus arereluctant to try a new approach


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Patients who may require intra-aortic balloon pumpcounterpulsation (IABP).

Patients who may require devices that are notcompatible in 7F or smaller sheaths (larger Rotoblatorburrs,

Patients with known upper extremity vascular disease.Some patients (less than 5%) will have congenitalabnormalities of their upper extremity arterial system(including extreme tortuosity, anomalous take off of theradial artery, or severe atherosclerosis).

Patients with Buergers Disease, severe Raynauds, orother forms of upper extremity peripheral vasculardisease.

Limitations


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Relative contraindications

Patients with known internal mammarygrafts contralateral to the site of entry. It

should be noted, however, that cathetersspecifically designed for IMA 's through aradial/brachial contralateral approach areavailable.

Patients in whom the radial artery may beconsidered as a conduit for coronaryartery bypass grafting


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0

1

2

3

4

5

6

80 y

n=110

Radial approach failure ra%

Radial Approach Failure Ratein Relation to Age

Y. Louvard, unpublishe


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Team work Learning curve Seniors Vs juniors Cath lab staff training Equipment Radial friendly cath lab !!! Dedication..


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Radial approach learning curve innon selected population

010

20

30

40

5060

70

80

90

100

1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90

Fellow 1Fellow 2

Fellow 3

52%69%89%

Y. Louvard, preliminar


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FEMORAL

32

RADIAL

0

0

5

10

15

20

25

30

35

40

45

50

FEMORAL

RADIAL

CATH LAB PROCEDURES -FEB-2011


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RADIAL

9

FEMORAL53

FEMORAL

RADIAL

CATH LAB PROCEDURES -MAR-2011


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RADIAL8

FEMORAL

65

FEMORAL

RADIAL

CATH LAB PROCEDURES -APR-2011


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FEMORAL

53

RADIAL

24

0

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50

60

70

80

90

100

FEMORAL

RADIAL

CATH LAB PROCEDURES -MAY-2011


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RADIAL

11

FEMORAL34

FEMORAL RADIAL

CATH LAB PROCEDURES -JUNE-2011


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FEMORAL48

RADIAL

24

0

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80

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100

FEMORAL

RADIAL

CATH LAB PROCEDURES -JULY-2011


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FEMORAL

33

RADIAL

7

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50

60

70

80

90

100

FEMORAL

RADIAL

CATH LAB PROCEDURES -AUGUST-2011


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FEMORAL

40

RADIAL

24

0

10

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60

70

80

90

100

FEMORAL

RADIAL

CATH LAB PROCEDURES - SEP-2011


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0%

10%

20%

30%

40%

50%

60%

70%

FEB MAR APR MAY JUN JUL AUG SEP

FEB MAR APR M AY JUN JUL AUG SEP

TREND FEB - SEP-2011


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FEMORAL

311

RADIAL

106

0

50

100

150

200

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300

350

400

450

500

FEMORAL

RADIAL

CATH LAB PROCEDURES FEB -SEP-2011


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RADIAL, 106

COMPLICATIONS, 2

COMPLICATIONSRADIAL

COMPLICATIONS


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TRANSFERMATION,

5

RADIAL, 106

TRANSFERMATION RADIAL

TRANSFERMATION TOFEMORAL


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RADIAL, 106

SPASM, 3

SPASM RADIAL

RADIAL ARTERY SPASM


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RADIAL, 106

ANAMOLIES, 3

ANAMOLIES

RADIAL

RADIAL ARTERYANOMALIES


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Dedicated day case unit with arm chairsrather than beds

Reaching 80-90% work load 8 Am admission 10 Am procedure 4 Pm home

FUTURE VISION


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THANK YOU


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THANK YOU


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World heart day

29-09-2011

29-09-2011

NWGH

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Trans Radial Cath at NWGH Peshawar